Clinical application of terminal ileum suspension in laparoscopic radical resection for low rectal cancer

Objectives: This paper introduces the surgical procedure of “terminal ileum suspension” in the radical resection for low rectal cancer patients and evaluates the possibility of its clinical application. Methods: This paper retrospectively analyzed the data of patients with low rectal cancer who underwent “terminal ileum suspension” during radical resection of rectal cancer (Dixon) in our hospital, and introduces the specific surgical procedures and key points of “terminal ileum suspension”. Observe the relevant conditions of patients during the operation, postoperative recovery and postoperative complications, and analyze the safety and feasibility of this operation (“terminal ileum suspension”). Results: The operation of all 8 patients went smoothly, and no anastomotic leakage, intestinal obstruction, and open diversion of suspended terminal ileum were found. The application of “terminal ileum suspension” in the operation of low rectal cancer has achieved ideal clinical effect, without increasing the rate of anastomotic leakage and rehospitalization, reducing the proportion of the secondary return operation, and reducing the pain of the patients. Conclusion: “Terminal ileum suspension” is a safe, effective and feasible surgical method for laparoscopic radical resection of low rectal cancer, which can be applied in clinical practice. doi: https://doi.org/10.12669/pjms.38.1.4721 How to cite this:Long-zhi Z, Bin Z, Jian-xin H, Wei L. Clinical application of terminal ileum suspension in laparoscopic radical resection for low rectal cancer. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4721 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A Novel Technique for Low Rectal Cancer: Pushing The Anus in Laparoscopic Radical Resection

10.21203/rs.3.rs-985961/v1 ◽

2021 ◽

Author(s):

Rui Yang ◽

Yuyi Yang ◽

Jianxin Li ◽

Qingqiang Yang

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Radical Surgery ◽

Radical Resection ◽

Low Rectal Cancer ◽

Postoperative Outcomes ◽

Conventional Surgery ◽

Novel Technique ◽

Surgery Group

Abstract Background In sphincter-preserving surgery for low rectal cancer, it is significant to reduce the number of stapler cartilages and the incidence of anastomotic leakage. On this basis, we have developed a safer and more economical technique— pushing the anus in laparoscopic radical resection of low rectal cancer. Method From January 2015 to July 2020, 213 consecutive patients with rectal cancer received laparoscopic radical surgery. For 151 of these patients, the surgeon used the stapler cartilages (Ethicon Intraluminal Linear Staplers EC60A, Ethicon, USA) to transect the edge of tumor of the rectum (Conventional Surgery Group). And for another 62 patients, besides applying the stapler cartilages, the surgeon had the assistants push the anus forward from the perineum during the process of transecting the rectum (Pushing the Anus Group). The postoperative outcomes and complications were compared between the two groups. Results In terms of the number of the stapler cartilages, the Pushing the Anus Group was less than the Conventional Surgery Group (P<0.001). Moreover, the incidence of anastomotic leakage in the Pushing the Anus Group is lower than that in the Conventional Surgery Group (P=0.043). Conclusions With pushing the anus forward during the process of transecting the rectum, the sphincter-preserving surgery can be performed more safely and economically.

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Clinical Efficacy of Different Approaches for Laparoscopic Intersphincteric Resection of Low Rectal Cancer: A Comparison Study

10.21203/rs.3.rs-958863/v1 ◽

2021 ◽

Author(s):

Wenquan Ou ◽

Xiaohua Wu ◽

Jinfu Zhuang ◽

Yuanfeng Yang ◽

Yiyi Zhang ◽

...

Keyword(s):

Rectal Cancer ◽

Disease Free Survival ◽

Radical Resection ◽

Postoperative Recovery ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Distal Margin ◽

Anal Function ◽

Free Survival ◽

Laparoscopic Intersphincteric Resection

Abstract Background: The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach.Methods: We retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n=142), the transabdominal perineal approach for ISR (TPAISR, n=57), or the transanal pull-through approach for ISR (PAISR, n=36).Results: The PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, three-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups.Conclusions: TAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.

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The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02223-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

I-Li Lai ◽

Jeng-Fu You ◽

Yih-Jong Chern ◽

Wen-Sy Tsai ◽

Jy-Ming Chiang ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Local Recurrence ◽

Distant Metastasis ◽

Resection Margin ◽

Radical Resection ◽

Hazard Ratio ◽

Low Rectal Cancer ◽

Distal Resection Margin ◽

Lymph Node Yield

Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

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Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer

World Journal of Surgery ◽

10.1007/s00268-013-2194-3 ◽

2013 ◽

Vol 37 (12) ◽

pp. 2935-2943 ◽

Cited By ~ 29

Author(s):

Takao Hinoi ◽

Masazumi Okajima ◽

Manabu Shimomura ◽

Hiroyuki Egi ◽

Hideki Ohdan ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Rectal Cancer ◽

Laparoscopic Anterior Resection

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The effect of increased body mass index values on surgical outcomes after radical resection for low rectal cancer

Surgery Today ◽

10.1007/s00595-019-01778-w ◽

2019 ◽

Vol 49 (5) ◽

pp. 401-409 ◽

Cited By ~ 2

Author(s):

Xubing Zhang ◽

Qingbin Wu ◽

Chaoyang Gu ◽

Tao Hu ◽

Liang Bi ◽

...

Keyword(s):

Body Mass Index ◽

Rectal Cancer ◽

Body Mass ◽

Surgical Outcomes ◽

Radical Resection ◽

Low Rectal Cancer

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Clinical application of self-closing ileostomy in anus-preserving surgery for low rectal cancer

World Chinese Journal of Digestology ◽

10.11569/wcjd.v28.i6.231 ◽

2020 ◽

Vol 28 (6) ◽

pp. 231-235

Author(s):

Xu-Tang Fu ◽

Hua Shao ◽

Peng-Peng Chen

Keyword(s):

Rectal Cancer ◽

Clinical Application ◽

Low Rectal Cancer

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Oncologic Outcomes of ypT1-3N0 mid-Low Rectal Cancer Compared with pT1-3N0 Disease After Radical Resection

10.21203/rs.3.rs-72204/v1 ◽

2020 ◽

Author(s):

Hong Yang ◽

Jiabo Di ◽

Ming Cui ◽

Jiadi Xing ◽

Chenghai Zhang ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Radical Resection ◽

Low Rectal Cancer ◽

Oncologic Outcomes ◽

Cancer Specific Survival ◽

The Difference

Abstract Background: Neoadjuvant chemoradiotherapy (CRT) can downstage rectal carcinoma, resulting in superior resectability, better local control and survival benefits. However, it is unclear whether patients treated with CRT and those who did not have similar outcomes at the same pathological stage. This study aimed to investigate the long-term outcomes of ypT1-3N0 mid-low rectal cancer who received neoadjuvant CRT followed by total mesorectal excision (TME) compared with pT1-3N0 rectal cancer immediately managed with surgery. Methods: We retrospectively enrolled 180 patients with pT1-3N0 or ypT1-3N0 rectal cancer located within 10cm from the anal edge who underwent TME between 2009 and 2015. Of these patients, 63 received neoadjuvant CRT, while 117 underwent radical proctectomy without preoperative therapy. The disease-free survival (DFS) and cancer-specific survival (CSS) were compared between the two groups. Results: Within a median follow-up time of 65 months, the 5-year DFS was lower in the CRT group than the non-CRT group (74.9% vs. 92.6%, P=0.001), and the 5-year CSS presented a similar trend as well (89.6 % vs. 97.1%, P=0.054). By subgroup analysis, the difference in DFS and CSS was mainly caused by the difference between ypT3N0 and pT3N0 disease (71.1% vs. 96.1%, P＜0.001 and 90.9% vs. 100%, P=0.029, respectively). However, patients with ypT1-2N0 had an analogous prognosis to those with pT1-2N0 disease (77.9% vs. 89.0%, P=0.225 and 88.1% vs. 94.2%, P=0.292, respectively). Multivariate analysis indicated that neoadjuvant CRT was not an independent predictor of DFS. Conclusion: After neoadjuvant CRT followed by TME, patients with ypT1-2N0 rectal cancer had an analogous prognosis to those with initial pT1-2N0 disease, whereas patients with ypT3N0 rectal cancer had worse prognosis compared with that of pT3N0 disease.

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Intersphincteric Resection for Low Rectal Cancer – Case Report

Acta Medica Marisiensis ◽

10.1515/amma-2015-0118 ◽

2016 ◽

Vol 62 (1) ◽

pp. 142-145

Author(s):

Cristian Russu ◽

Călin Molnar ◽

Sanda Maria Copotoiu ◽

Claudiu Sărăcuț ◽

Mircea Gherghinescu ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Multimodality Treatment ◽

Functional Results ◽

Radical Resection ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Cancer Case ◽

One Year

Abstract Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome. Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions) followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up. Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

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